Left ventricular systolic and diastolic function after total correction of tetralogy of Fallot

Left ventricular (LV) systolic and diastolic function was assessed in 12 patients after total correction of tetralogy of Fallot (age range 5 to 18 years, mean 10) and compared with 10 control patients. Only 1 patient had a shunt before total correction that was performed at a mean age of 3.5 years, (range 0.3 to 8). At cardiac catheterization the following indexed LV parameters were measured: end-diastolic and end-systolic volumes, wall mass, ejection fraction, stroke volume and end-diastolic and end-systolic pressures and stresses. The rate-corrected mean velocity of fiber shortening was calculated. LV diastolic operant chamber stiffness and myocardial stiffness were calculated from simultaneous diastolic pressures and volumes in mid- and late diastole using monoexponential formulas. The 2 groups were compared by unpaired t tests. The tetralogy group had higher mean end-diastolic (93 vs 74 ml/m2), end-systolic (29 vs 19 ml/m2) and stroke (64 vs 55 ml/m2) volumes than controls. Rate-corrected mean velocity of fiber shortening was lower in the tetralogy group (1.07 vs 1.24). Myocardial stiffness was higher in the tetralogy group (16 vs 11). Other indexes were not significantly different. Thus, LV function after total correction of tetralogy of Fallot may be abnormal with larger than normal LV size, decreased contractile function and increased myocardial stiffness.     

Double-blind placebo-controlled trial of corticosteroids in children with postpericardiotomy syndrome

Summary The objective of this study was to assess the efficacy of corticosteroids in hastening the recovery of children with postpericardiotomy syndrome, using a randomized double-blind placebo-controlled trial in a tertiary care referral center for pediatric cardiology and cardiac surgery. Twenty-one children, 6 months of age or older (mean age 3.9 years) with postpericardiotomy syndrome following open or closed heart surgery were administered either prednisone 2 mg/kg/day reducing to zero over 14 days (n=12) or placebo (n=9). Progress was monitored by daily clinical assessment and alternate day cross-sectional echocardiograms. The primary measures of efficacy were the number of patients in remission at 72 h and at 1 week. No difference in remission rates were found at 72 h, but at 1 week significantly more children treated with prednisone were in remission (placebo 3/9; prednisone 10/12,p=0.03). A trend to faster resolution of all symptoms and signs was seen in the prednisone-treated group but this was not associated with earlier hospital discharge. Enlargement of pericardial effusion was seen in two children treated with steroids. No complications of treatment were encountered. Prednisone hastens the recovery of children with postopericardiotomy syndrome. Pericardial effusions may increase in size despite the use of corticosteroids.Presented in part at the Society for Pediatric Research, New Orleans, May 1991.     

Influenza--United States, 1989-90 and 1990-91 seasons.

During the 1989-90 influenza season, 98% of all influenza viruses isolated in the United States and reported to CDC were influenza A. Almost all those that were antigenically characterized were similar to influenza A/Shanghai/11/87(H3N2), a component of the 1989-90 influenza vaccine. Regional and widespread influenza activity began to be reported in late December 1989, peaked in mid-January 1990, and declined rapidly through early April 1990. Most of the outbreaks reported to CDC were among nursing-home residents. Considerable influenza-associated mortality was reflected in the percentage of deaths due to pneumonia and influenza (P&I) reported through the CDC 121 Cities Surveillance System from early January through early April. More than 80% of all reported P&I deaths were among persons greater than or equal to 65 years. In contrast to the predominance of influenza A during 1989-90, during the 1990-91 influenza season 86% of all influenza virus isolations reported were influenza B. Widespread influenza activity was reported from mid-January through April 1991, with regional activity extending into May. Outbreaks were reported primarily among schoolchildren, and no evidence of excess influenza-associated mortality was found. Almost all the influenza B isolates tested were related to influenza B/Yamagata/16/88, a component of the 1990-91 influenza vaccine, but were antigenically closer to B/Panama/45/90, a minor variant.     

The worker with no training in nursing in a center of materials and sterilization: a challenge to the nurse

The object of this study was to characterize the process of insertion in the Centros de Material e Esteriliza??o - Center of Material and Sterilization (CME) of workers who have no specific formation in the area of Nursing. Seventy-five workers of two public hospitals took part in the study. After the observation of the legal ethical aspects, data was obtained through a questionnaire previously validated and tested. The study found 15 workers without specific formation, who came from different intra- and extra-hospital services. They had not been submitted to selection processes nor to training, and had learned the work routine with co-workers. This is worrisome, considering the worker's occupational risk, the risks this situation represents for the quality of the reprocessing of hospital items and the conformity to the legislation that governs professional practice.     

Items sterilized in humid heat: validation of the storage system

We aimed at identifying the period of validity of the sterilization of items by humid heat, taking into account the conditions of sterilization and storage. The validation was carried out by means of microbiological tests performed with instruments in the same load and evaluated in 0, 7, 10, 15, and 25 days. 30% of the instruments in each package were analysed and put in a Mueller Hinton solution and incubated at 37 degrees C for 72 hours. The reading was accomplished taking into consideration how dark the solution was. Out of the samples evaluated in nine loads, none showed microbiological growth. It was concluded that, although sterilization and storage conditions of the material were not fully in accordance with parameters recommended by the literature, the sterilization happened and was maintained for a period of 25 days.     

Teaching infection control: a theoretical and practical essay

This article contains reflections concerning infection prevention and control measures starting from the adherence of health professionals to prevention measures. It points out worrisome environment-related aspects stemming from the use of disposable materials in spite of the benefits that they represent in terms of safety and reduction of operational costs, among others. All these issues are presented as a challenge to infection control teaching in the education of health professionals. Some guiding presuppositions are also presented.     

Pulmonary artery banding: results and current indications in pediatric cardiac surgery

The results of pulmonary artery banding in 144 patients seen from 1971 to 1984 were reviewed. Age ranged from 1 week to 4 years (median, 8 weeks) and weight, from 1.1 to 16 kg (median, 4 kg). The patients were divided into three major groups: Group 1, defects without mixing disorders (ventricular septal defect, double-outlet right ventricle [DORV], atrioventricular septal defect); Group 2, defects with mixing disorders (transposition of the great arteries, DORV, single ventricle, tricuspid atresia); and Group 3, miscellaneous (mitral atresia, left ventricular hypoplasia, truncus complex). The diagnostic group influenced survival (p = 0.0035). In Group 1, 88.8% survived, but only 64.9% survived in Groups 2 and 3 combined. The presence of patent ductus arteriosus or coarctation of the aorta had no effect on survival (p = 0.61 and p = 0.7, respectively). The clinical condition at thirty days after pulmonary artery banding was good in 35.1% and fair in 46.9% of the patients. When the data were divided into the three periods 1971 through 1974, 1975 through 1979, and 1980 through 1984, which included 28, 49, and 67 patients, respectively, a significant improvement in survival was observed from the early (64.3%) to the late period (92.5%) (p = 0.0009). Patients weighing less than 4 kg had a significantly lower survival in the period 1971 through 1974 (37.5% versus 91.67%). No significant difference in survival was detected in the late period, 1980 to 1984 (90% versus 94.6%), between patients weighing less than and those weighing more than 4 kg. Pulmonary artery banding is clinically satisfactory in small infants and children with complex anomalies.     

Surveillance for pneumonic plague in the United States during an international emergency: a model for control of imported emerging diseases.

In September 1994, in response to a reported epidemic of plague in India, the Centers for Disease Control and Prevention (CDC) enhanced surveillance in the United States for imported pneumonic plague. Plague information materials were rapidly developed and distributed to U.S. public health officials by electronic mail, facsimile, and expedited publication. Information was also provided to medical practitioners and the public by recorded telephone messages and facsimile transmission. Existing quarantine protocols were modified to effect active surveillance for imported plague cases at U.S. airports. Private physicians and state and local health departments were relied on in a passive surveillance system to identify travelers with suspected plague not detected at airports. From September 27 to October 27, the surveillance system identified 13 persons with suspected plague; no case was confirmed. This coordinated response to an international health emergency may serve as a model for detecting other emerging diseases and preventing their importation.     

Nurses' understanding of standard precautions at a public hospital in Goiania - GO, Brazil

Standard Precautions (SP) are effective strategies to prevent and control nosocomial infections. This study aimed to verify nurses' understanding about standard precaution measures. Data were collected through interviews, followed by content analysis in accordance with Bardin. Eighty-two nurses took part in this study, 75.6% of whom understand SP as protective measures: for professionals (11.0%); for both professionals and patients (52.4%); for patient care independently of the diagnosis (7.3%); for patients with diagnosed infection (9.8%). Other nurses indicated SP as human care (4.9%) and only as Individual Protection Equipment (IPE) (11.0%). Most participants' understanding points to favorable cognitive adaptation to the daily implementation of SP. However, reductionist and even mistaken perceptions about their range persist, which makes the social function of these measures vulnerable.